Talking About Psychosis, Part 1: Why Do It?

Mark Ragins, MD
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I was taught in medical school and psychiatric residency not to talk to people about their voices and their delusions:  “It will only feed into them and make them worse.”  Nor was I supposed to argue with people with paranoia because they’ll just get agitated and won’t change their mind anyway.  We were taught that the psychoanalysts had wasted a lot of time trying to connect people with psychosis by trying to find meaning in their psychosis.  I was taught that there is no meaning.  All we needed to know about their psychosis was enough to prescribe medications and assess if the meds worked.  The venerable Chestnut Lodge where Frieda Fromm-Reichmann had treated the woman in “I Never Promised You a Rose Garden” with psychoanalysis was successfully sued for not providing research-proven meds instead of talking with patients with psychosis.

Beyond that, I was told not to try to relate to the patients in the State hospital because they couldn’t handle relationships and when I left they’d feel abandoned and decompensate.  Most of my medical school class mates were more than happy to follow that advice and left the ward as fast as possible. They already knew that “people with psychosis are creepy and frightening and frustrating anyhow” without having met any of them.

But what happens if you don’t talk to people with psychosis and just medicate them?  Sometimes their psychosis gets somewhat better, but usually they’re stuck with disabling “negative symptoms”.  They’re emotionally blunted, slowed, poorly motivated, disinterested, withdrawn, etc.  I was taught I had to wait for a new medication to be developed to help those symptoms because the current ones didn’t help much.  Talking to them was a waste of time that should be spent on “high-functioning” patients instead.

The other thing that happens sometimes if you don’t talk to people with psychosis and just medicate them is that they get less psychotic and can’t adjust to their sudden change in reality.  In the early days of the long acting antipsychotic injections the British Health Service, public nurses went out into the community making sure their patients with schizophrenia got their shots.  Unfortunately quite a few of their patients killed themselves.  Initially they wondered if increased suicidality was a side effect of the medications, but they eventually decided that their patients had killed themselves because no one had helped support them to come to terms with what they’d been going through, the losses they’d suffered, the internal and external stigma, and, putting it bluntly, how to go on with life after realizing they’d been diagnosed with a mental illness and medicated.

Several decades later some people noticed that adolescents diagnosed with major depression and given antidepressants are more likely to be suicidal too.  We wondered if increased suicidality was a side effect of the medications and put a black box warning on them.  By this point we’ve become so obsessed with medications we never asked if they too killed themselves because no one had helped support them to come to terms with they’d been going through, the losses they’d suffered, the internal and external stigma, and, putting it bluntly, how to go on with life after realizing they’re diagnosed with a mental illness and medicated.  Most antidepressants were handed to them by a primary care doctor after a cursory visit or maybe a depression screening.  No one spent time talking to most of them.

It can take “two to avoid”.  Most people don’t want to spend time talking with a mental health professional about their “symptoms” either.  Some of this is because of the way mental health professionals act, but most of it is because it’s unpleasant to really talk about painfully distressing mental and emotional challenges.  “Can you just give me my pills and let me get out of here as fast as possible?” is a common treatment request and plan even though it’s not very effective.  Some people don’t perceive themselves as “mentally ill” or “psychotic” or “symptomatic” in the first place.  They’re likely to avoid talking with mental health professionals who insist on putting their experiences into those categories and try to find someone whose perspective is more similar to theirs to talk with instead.

Over my career I’ve heard about several promising developments for treating psychotic people – CBT for psychosis, peer support, dialogic therapy, and “voice hearers” – but none of them ever get used much.  Why?  I think that one of the reasons is that we’d have to actually talk to people with psychosis, usually in depth about their individual experiences of psychosis, to use any of those techniques and we’re unable to or simply refuse to do that.

Think about it for a minute.  How are we going to help people develop more positive ways of thinking about and interacting with their voices without talking in detail about how they think about and relate to their voices now?  The CBT approach requires going back to the earliest moments of psychosis to see how personal experiences emerged.  How are we going to support someone as a peer without sharing details with each other that demonstrate true understanding and empathy?  How are we going to make a dialogue with someone while purposefully ignoring the most compelling experiences they have?  And how are we going to help people adapt to voices as part of their identity, and even help some people develop personal understandings of what they’re going through without using psychiatric terminology – including “psychosis” – without getting into personal, subjective detail?

Maybe, just maybe, we have to learn how to talk to people about their psychosis if we’re going to help them recover.

Let’s think about the Wunderink study again with the assumption that talking to people about their psychosis might be very important, instead of assuming it’s irrelevant.  My understanding is that In that study, they took a group of people with schizophrenia who were stabilized on their medications and divided it in half.  One half was instructed to stay on their medications at their current dosage indefinitely to stay stable.  The other half was supported in lowering or even coming off their medications if possible.  Although only a fraction did succeed in getting off their medications and that group had more relapses in the first six months than the maintenance group, but by one year the groups were evening out and by two years the dosage reduction group was doing better than the maintenance group.  Also, after two years far more people in the dosage reduction group were working than people in the maintenance group was.

Let’s imagine for a moment how the conversations about psychosis that the two groups likely had.  The maintenance group likely was handled in the customary way, checking their symptoms and side effects in perfunctory med visits while refills were written indefinitely.  By contrast, the psychiatrists in the dosage reduction group probably had to keep talking about symptoms in some detail to decide whether to keep reducing meds or leave them alone or raise them back up.  Over time they likely trained their patients to observe their symptoms in some detail to avoid repeating all those early relapses and to make better medication decisions.

I can imagine how those medication conversations over time led to people being more observant of their own symptoms, learning what helped and harmed them, learning when medications did and didn’t help, all the while gaining some mastery and control over their symptoms and indirectly their lives.  Maybe they did better and better, not because of a biological reason, but because they were learning to come to terms with what they’d been going through, the losses they’d suffered, the internal and external stigma, and, putting it bluntly, how to go on with life after realizing they’re diagnosed with a mental illness and medicated.

Meanwhile the maintenance group just went on passively depending on their pills to stay well, and that worked less and less well over time.

Maybe, just maybe, how we talk to people about their psychosis is really important.

40 COMMENTS

  1. Dr. Ragins,

    Thank you for the nice article. In my own experience, meaning and psychosis is very closely related, which is why psychosis has such tenacity–the delusions are oftentimes symbolic statements about our lives that are taken in universal and literal ways.

    I imagine with decades of experience with working with people like me, you have many thoughts about the psychosis, meaning and dialogue, as well as the value of viewpoints of people who have experienced it. The works of Paris Williams and Gail Hornstein, for example, can help give light to the experience.

    Through volunteer work and some small research projects, I’ve also collected material on psychosis, meaning and ways to merge the various peer and family developed approaches into a multi-faceted approach to both help the person recover as well as transform his or her life based on insights gained from meaning within psychosis. I don’t want to self-promote, so I won’t mention the names of the books here, but if you think you might be interested in looking at them feel free to email me at [email protected]. (They are available at online book sellers, so you can look for them there as well…) At this point, they seem to be well-received, though one is new so there’s been limited responses to it.

    In any case, thank you for your work many years of work on behalf of people like me.

    Milt Greek

      • Thanks for coming to that talk. I am glad you found the material useful. It was actually at the NYC conference that I met someone who sent me Paris’s original Ph. D. dissertation, after having just met (at a conference the week before) one of people who served as a “case study” for Paris.

        I’m actually starting a sabbatical now (while still working full time at my regular job), but I recently came out with a new book which I feel is much more expansive than the material I presented in NYC. If you have any interest, contact me as the email above and I can email you the material as an attachment free of charge. If you don’t have the first book, I can send you that as well.

        I have to ask you not to share the book with others, but since I’m not dependent on book sales for meaningful income, I can share the material a little more freely than if I needed for money to support my family.

        Thanks for your work with peers and for your willingness to share and learn from others.

        Milt

  2. This is what I remember being told in the early eighties after graduate school. Ignore the psychosis and the delusional thinking. My graduate learning was more open but you must follow what your employers say once you start working. I am so sorry for taking on that mindset.
    As a person with a lived altered state triggered by trauma, stress, and marital abuse I applaud your written words on this issue.

    I would have gladly told and discussed my altered states to any professional that felt safe. Most times they didn’t and weren’t safe.
    It is only after more than ten years and with the help of this site and readings that I have been able to try and begin to piece together the broken pieces of my life after Mental Health intervention.

    I was so traumatized by so called friend’s nonprofessional intervention and the effect it had when they called my mother whose other daughter was dying of breast cancer and had three small children including an infant that my mind literally broke. There is nothing worse than hearing your mother site the symptoms of Bi Polar Disorder that she was given over the phone and you had to push to get her to tell exactly what your so called friends had reported. There is nothing worse than three months down the line finding out your husband was aware and agreeable to so called intervention even though he did admitted he didn’t think it would be the best thing for you to deal with.

    All because I told my friends I thought the marriage was in trouble and something was wrong with my husband. Yeah something was wrong – verbal abuse that was kept hidden until lately. I had to leave and it was only through time and an excellent therapist that I have been able to identify,label, and see the verbal abuse pattern in my marriage.

    If I had been taken to Chestnut Lode in the 1950’s my delusions of the end of the world would have been seen as a metaphor for my fears over leaving a marriage with five children including some with special needs and a dying sister to boot. My delusion of a ship being in the sky and I was the one who could get it and get help from it would have been seen as another very creative metaphor for feeling totally responsible for matters of family.My acute depression and anger at not being able to find a space ship that would help would have been seen as another creative metaphor for my acute emotional distress for not being able to save my only sister from death and save my children from the anathema of a broken marriage.

    It was safer to displace and project my anger onto the so called others than to put it where it belong on my husband who was a failure at emotionally supporting me during oncurring family medical crisis.The PSTD issues I now have are solely the result of my horrific experiences in the hospital and the hard side effects of medication. Once you suffer from Parkinsonism you never forget the incapacity.

    My problem is and I fear it may always be an issue is that because it was trauma induced. Because I saw my aunt experience a short episode of an altered state in the ER when her sister with RA had fallen after visiting me for my graduate degree graduation ceremony in the lobby of the hotel shortly after their arrival – and because after several of my own hospitalizations my mother admitted I had a great aunt with an almost constant altered state that was able to still work as a cook I will be at risk for other altered states.

    No one has seemed to talk of Prn psychotropics. When I have had an altercation with my husband and can feel my brain begin to start fragmenting I have found describing it as break through anxiety warrants a psychopathic script and in 15 days my altered state thinking has disappeared and I am fine unless another emotional trauma occurs.

    I am starting EDMR therapy but the history sessions have been hard and long.
    i am hoping to detrigger myself and also learn new techniques I can use when emotional trauma comes my way once again.

    My guess is that in my Irish heritage there have been many folks who have endured altered states. In my Social Work career I learned early ont here is nothing new under the sun.My relatives come from the rural West and my best guess is that they and other have used alcohol and sheer stubborn denial to deal with their experiences.

    Fear is a huge factor is treatment. This needs to be addressed for all those involved people with lived experiences and all the papraprofessionals and professionals that come in contact with us. Almost every aspect of our society paints a negative and fearful view.

    it would help if I were to tell my story but I find that I would need much support and that isn’t likely in my locality or in my family at this point.

    • Thanks for sharing your story – it was very moving and sad to me, having seen similar events happen many times over my career. It is a very common thing for PTSD sufferers, including those currently still suffering abuse from parents or abusive partners, to be labeled with psychiatric “disorders” (especially “bipolar) and given drugs to suppress their symptoms. This definitely relates back to what Mark is saying in the piece above – no one really bothers to ask why you might be feeling, thinking or acting the way you are. The assumption that mental/emotional “symptoms” have no meaning is completely wrong and destructive, and you were massively disserved by the system not bothering to find out what was really prompting your symptoms. You showed great strength in persisting despite the barriers, and I have confidence you will continue to heal.

      Thanks again for sharing, and I hope you continue to post. You have a lot of good and important things to say.

      —- Steve

      • Thanks for your reply madmom. Your daughter is lucky to have a parent so advanced in their thinking and assessment.l I don’t have a support group and pursuant to another thread I recently posted on couldn’t find one in the Unitarian Church. My state has recently started to train peer support but NAMI has their hands all over it. The agency tries to hold a middle ground but it is clear I have been and will be the odd person out with my experiences.
        I have worked with the docs on the NAMI board prior to my hospitalizations and that is the scariest for professional folks to deal with. How could a supposed excellent clinician with mid management experience end up in an altered state. If I could then they could easily as well. The concept of a Soteria House and or program is very very scary for them. Medication is all. There is a lot of politics in my county and it affects everything. I found out that one of the major medical players lost a lawsuit so that makes them even more angry and fearful of alternative view point.s Oh well. Someday I hope to move!

        • Hiya CatNight – Nothing much but appreciation for me to express, I see. But if it might suit you to hear it, or lead to a healing thought, I will chance a further word. When you get a therapy set-up that seems to help you, you got it set up, the therapist sat in. What they have to occupy themselves with, if it works to your benefit, works as much from depriving them of opportunities to compromise the openness of the space or legislate within it what rates well or deserves attention or doesn’t as does to qualify the proof of the outcome in your eyes or theirs.

          You have tons of experience that would essentially serve me and most people very well. You don’t seem like you would want anyone to have to do what you did, and especially run into the malfeasance and rigidity endorsed as proper advice and best care practices.

          I personally ever knew only one psychologist who was able to give herself over to her responsibility to advocate for me in the space that opened between us suitable for that purpose. The impression settled in for me ineluctably that if the person with whom my interpersonal conflict had developed were to follow me in some future session of his with this same female therapist in charge, I would have complete confidence that she was advocating on his behalf, and was now working for him to come to terms with something uncomfortable or restrictive in our dealings together, something that was not worth much attention except to clear it up so he could get to move on.

          Maybe that could only happen in a relationship that was limited by ethical rules of conduct like therapy is supposed to be. Anyway, if it hadn’t been for that, I would not have distrusted bad care so much when I got it due to other different problems later on.

  3. DR. Raglin:

    Thank you for posting this. I can only hope that the conclusions you appear to be reaching will be shared by others in your field.

    I have been talking to my daughter for years about her psychosis, learning a lot in the process, and I can assure you that not only is there meaning in madness but accepting that madness, as a coping mechanism for trauma is a tolerable state that can provide insight, even humor, is the best first step to a full recovery. Yes, there are many tears but psychosis can involve joy too.

    It takes time and no amount of pushing and hurrying will help. The meds can delay recovery and make psychosis settle in to the point where people like my daughter make psychosis a career. I hold people in your profession accountable for many myths about psychosis and for practices which delay recovery and cause despair, stigma, and death.

    I hold your profession accountable for allowing parents, through the big Pharma funded NAMI to run rampant with an agenda that is counter to recovery and empowerment. My husband and I are creating a label free household where choice and privacy are respected so we have little to do with NAMI.

    Maybe your clinic should drop all the labels and pretenses and remake your institution into a safe sanctuary where individuals in crisis are protected from harm and given real choices not pseudo choices.

    I’ve come to the conclusion. that the diagnosis, stigma, isolation, institutionalization, and forced sedation, plus having all of my beautiful young adult daughter’s rights taken away through involuntary commitment, have harmed her deeply, much more so than the events in her life leading to her emotional break down.

    My daughter claims that her voices did not start until she was pinned down by four orderlies and forcibly medicated in retaliation for trying to escape from a hospital. I believe her.

    She has been cycling in an out of hospitals ever since. The ‘treatment’ that she received was absolutely barbaric during her first break and I am deeply ashamed that I failed to protect her from psychiatric harm. Our entire family has been traumatized.

    Her PTSD-like symptoms stemming from her ‘treatment’ can be triggered in a flash, but generally, as her brain adjust to the over-medication with a cocktail and double doses of several anti psychotic drugs, she is slowly becoming docile and apathetic and the more docile and apathetic she becomes, the more her treatment therapists glow about her ‘progress’. Meanwhile, I am absolutely convinced that her psychosis is simply getting more embedded and she is learning to mimic ‘saneness’. Each year that she is kept on these terrible, brain damaging sedatives, the more difficult it will be to wean her safely off, as her dopamine system has basically been dismantled to the point where she will no longer have the will power to even learn how to govern emotions and behavior. Why bother, just up the dose, please. It is called despair and learned helplessness.

    I believe that we can support her through a full recovery but to support someone who has been this deeply traumatized by all the horrors that psychiatry has to offer, is a long and slow process. currently she is institutionalized. When she is home, we are accustomed to having long, slow talks about everything under the sun, including unpleasant topics and things that he holds dear that others would call ‘delusions’ but when we visit her in an institution, someone is often listening in, just as in a jail, and we must discuss her psychosis covertly or avoid the subject all together in order not to earn any family ‘demerits’. Everything makes it into a written medical records that dogs the individual and the family and will be used in a court hearing at some point; make no mistake about that. The entire court system is geared to listen to the psychiatric ‘authority’ not the family members, and god forbid, the patient.

    Just for once, I would like to have conversations with my daughter without the fear of being overheard. Then we could speak as we do at home, without fear of triggering rage, anxiety, fear, and grief. Those emotions are important to recovery.

    The risk that these emotions will get triggered is very great when one talks to someone about their psychosis. One of the reasons why psychiatrists are NOT trained to talk to their patients is because authentic dialogue entails risk; Providers fear that by talking, unpleasant emotions will be elicited which they are not prepared to handle, and it will also reveal the stark power imbalance. Authentic dialogue may also reveal how little latitude conventional treatment providers have in the current paradigm of care and make the treatment provider ill.

    If treatment providers really wanted to help their patients, they would deal with the issue of power imbalance head on. A good treatment provider will go out on a limb i.e. risk his/her career or standing with his/her peers, in pursuit of building trust and doing right by a patient. And if a treatment provider goes out on a limb for a patient and is disappointed as a result, then the treatment provider gets help so the treatment provider will not over/under-react to a single failure and instead put things in perspective so he/she is able to go out on a limb again and again.

    If treatment providers would meet their patients in more open and relaxed environments, not clinical settings which are basically fishbowls: lots of people crammed into artificial environments, with guards and doors that lock, alarms that go off, etc. that would be a first step.

    The second step would be for a treatment provider to admit that he/she also needs help.

    • My heart goes out to you and your daughter! I can’t refute a word that you said. What passes for help these days is outright abuse, and docility seems to be the gold standard of treatment “success.” Your daughter is lucky to have you to provide a contrast. She sounds like a perfect candidate for an “open dialog” intervention, if only we could break out of our pharma chains and develop such options here in the USA.

      Thanks for sharing!

      — Steve

    • I am so sorry for what you and your daughter and entire family are going through. I know what you’re talking about when you’re saying that:
      “that the diagnosis, stigma, isolation, institutionalization, and forced sedation, plus having all of my beautiful young adult daughter’s rights taken away through involuntary commitment, have harmed her deeply, much more so than the events in her life leading to her emotional break down.”
      I too suffer hospital-induced trauma which has caused much more suffering that whatever caused my mental breakdown in the first place. If that didn’t happen I’d probably be 100% OK now, not having to deal with the anger and memories of abuse.

    • Dear madmom
      I can understand your struggle. I was a professional psychiatric patient for about 4 years.
      You’re right about the ‘medication’, it turns people into longterm patients. So once a person gets ‘labelled up’, they are in real danger of becoming the property of the Psychiatric Services.

  4. Thanks for this post, Mark. In my training, I too was taught (more acculturated) to the idea of not engaging w/ people having anomalous experiences, hearing voices etc… Too often, MH professionals respond w/ fear, hopelessness and avoidance – and a peremptory referral to a Psychiatrist such as yourself (what could we do about chemical imbalances?)
    CBT tries to “decatastrophize’ the experiences – as important for providers as it is for distressed help seekers. Be respectfully curious about meanings, enhance coping, reduce stress if possible.
    I think it’s notable that in the Eleanor Longden TED talk, she points out that it was the frightened over-reactions to her voice hearing that precipitated her struggles. It was as if she was taught to fear and distrust her voices that intensified her suffering.

    • Well, it’s standard practice to physically assault and restrain patients who have the audacity to shout at you. Since as we all know someone shouting is a danger to self and others and can cause irreversible loss of self-esteem in the professional involved.
      Any emotion you display is penalized and labelled as a symptom.

  5. RE: I was taught in medical school and psychiatric residency not to talk to people about their voices and their delusions: “It will only feed into them and make them worse.”

    How much worse could it get ?

    Hang around when two or more people in the hospital get together with similar ideas, my roommate was telling people how the hospital was not a hospital, it was actually the CIA doing mind experiments and some were believing him and feeding into it. See how they follow you around with those clip boards and they are constantly watching on those surveillance cameras so don’t tell anyone you know whats really going on.

    I think putting those big ugly surveillance cameras in a persons living environment are the most diabolical torture anyone one could inflict on someone who is paranoid.

    When I took a crayon and fouled the lens of the camera in the day room the fact no one ever came to clean it also fouled up this guys delusions.

      • Sorry about your arachnophobia, nothing we can do. Those spiders are for your “safety”, its all about safety, they eat bugs like cockroaches that have many negative consequences for human health because certain proteins (called allergens) found in cockroach feces, saliva and body parts can cause allergic reactions or trigger asthma symptoms, especially in children.

      • Funny, but it’s the same analogy I had in mind when after I told the “good professionals” at the hospital that I have a life-long phobia against needles and injections they decided that the best thing for them to do is to subject me to “needle-rape”, daily blood checks and leave the venflon in my vein (which I took out at every opportunity – a clear sign of mental illness).
        I wonder why someone may suggest psychiatrists are sadists?

    • “Re: I was taught in medical school and psychiatric residency not to talk to people about their voices and delusions: ‘It will only feed into them and make them worse.'”

      My psychologist told me I should quit all my real life activities and concentrate on the med induced voices. But the drug induced voices were too stupid for me to want to talk to, so I didn’t.

    • Honestly, after the Snowden’s revelations I’ll be very cautious to label anyone paranoid ;). CIA has actually sponsored and facilitated experiments in psych wards in the past as described by N. Klein in her book “Shock doctrine”.

  6. Great article, Mark! You have hit in the black on exactly what does not work about the current paradigm. The WHO studies showing much better results in developing countries for schizophrenia probably reflect the long-term adverse effects of drug treatment, but I am betting they also reflect how people in those cultures react to “delusions” and “hallucinations.” In so-called “primitive” cultures, those manifestations get you some special training as a shaman. In our “modern” world, it gets you shame, isolation, and humiliation, to the point that no one is even allowed to talk to you about your personal reality. How can that be helpful?

    Milton Erickson and many others did great work helping people suffering from “psychosis” by talking to them. Apparently, Erickson and his ilk would be sued for malpractice today. It is appalling. I’m glad there are a few like yourself willing to recognize that not talking to people about what is real to them is about as smart as improving your car engine’s functioning by adjusting the tuning on the radio. It is idiotic, but it is standard practice. It makes me ill to see this stupidity as the standard of care!

    —– Steve

    • Honestly, I think not only the “professionals” should stop hiding from the issue – general public needs to talk about psychosis as well. Before coming to MIA I have not once heard a story of how hallucinations and delusions are like from a person who has actually experienced them. Funnily, if you go to the press and all the “anti-stigma” campaigns, they almost never bother to ask people with these experiences – they only talk to doctors and parents who all say how bad it is and how much the person needs to be on meds and how little the meds “help” (which of course means we need more of them). Nothing from the people who should be the ones listened to.
      The whole narrative our society has about psychotic experiences is a disgrace.

  7. Mark,
    First look yea at your own “psychosis” in believing so strongly you know so much more then you really do. After telling us how ridiculous your formal education experience was you still tell us you are some kind of “professional”. Sounds like to me you just acquired the exclusive privilege of accumulating funds by dispensing chemical lobotomy poisons . Emersed in pseudo science you stride forward. Try taking 800mg of thorazine a day for a month . Have even one bilateral shock treatment without sodium penathol. I promise you for the rest of your natural life you will not forget the experience no matter what you do. But your arrogance about your knowledge will be sharply reduced.
    You’re either learning or using marketing skills to lure in more unsuspecting victims .
    I suggest you beg Paris Williams to teach you and Alex who comments at MIA, I no longer have the patience . You can pay them with your ill gotten gains.
    You will have graduated when you voluntarily pay reparations and realize the only activity that makes sense is pushing whipped creme pies, in the faces of most all your fellow psychiatrists, in public places. We must abolish this diabolical “profession”. Join us.
    You want to know more of my thoughts Just press the cursor over my name.
    Sincerely, Fred (5 time actual escapee from mental hospitals and torture survivor and natural healer)
    I’ve always said people come in strange packages.

    • Fred Abbe, I feel terrible that those things were done to you and that the past cannot be changed. It sounds as if you are doing well; maybe you were able to migrate out of the system without assistance from the mental health system by pulling yourselves up by the bootstraps. But some of us may not be as strong. Some of us need the help of an insider ally to get free of the psychiatric merry-go-round nightmare and to help a loved one wean slowly and safely off toxic meds and enjoy a return to easier, gentler times. Let’s not use this author as a target for everything that happened to you or me or my daughter. I too, am upset by the field that he represents but people are capable of being change agents. If we support this person’s efforts, then he could do a lot of good. Perhaps he will persuade his peers to treat their patients as human beings and talk to them in depth, not just give them monthly, fifteen minute ‘med checks’; That would be huge. Maybe he will publish articles in mainstream journals calling for new approaches, at least those journals that haven’t been bought by big Pharma yet. Maybe he will call his legislator and tell him/her to vote NO on the Murphy Bill. Maybe he will, maybe he won’t but let’s give him the benefit of the doubt.

  8. Dr Ragins, I find it interesting that you focus on the losses experienced by those of us forced into the “mental health” system. Certainly we experience multiple losses: layered, repeated, and increasing over time. Instead of having our losses acknowledged so that we can grieve, we are told we are “depressed” and given another prescription. Acknowledging loss and allowing people to grieve can be powerful steps toward recovery.

    I also agree with the direction you are taking with regard to hearing voices. I was fortunate to be trained in the model of Hearing Voices Network, and to have the opportunity to participate in and even facilitate these groups. As you know, we absolutely talk about voices, visions, and unusual beliefs. I began to discuss–and then understand–experiences I had literally never shared with anyone else before, as a result of participating in these groups. I’ve seen that experience repeated over and over again. The Hearing Voices Network model is also one that can–and should–be offered separately from any medical provider, so it often feels more safe to the vast majority of us who are trauma survivors.

    I wonder, however, if you are really trying to say that the unacknowledged losses are the reason people sometimes feel suicidal and/or violent on certain classes of meds. Having experienced this very effect from some meds, I can say that in my experience, the powerful urge to hurt myself or someone else had nothing to do with unacknowledged loss, and everything to do with the drug: the feelings were dose-related and dimished rapidly when I stopped taking it. Fortunately, I realized it was the drug because my prescriber didn’t understand akathisia and dismissed my concerns. I was left to figure it out and resolve it on my own.

    • That also reflects my own experience with suicidality. I’ve experienced a lifetime of people not supporting me. I’m completely used to it. I would imagine this is the case with a lot of people with lived experiences of “psychosis.” The lack of support might bother me a lot, but I can live with it. It’s the unbearable physical and mental effects of the drugs that make me want to kill myself.
      Also, I have to wonder if talking to someone about their psychosis should trump just talking to them, the same way you would talk to anyone else? It’s not like people with psychosis don’t have “high functioning” aka regular, everyday problems. Ignoring someone and hoping they go away is a pretty crap way to treat anyone, much less someone who it’s your job to help.

      • “It’s the unbearable physical and mental effects of the drugs that make me want to kill myself.”
        Or the trauma of physical abuse experienced at the ward – involuntary commitment, restraint, forced injections, being kept in a net bed (a type of bed-cage: basically being kept like an animal in a zoo), threats and intimidation, forced nakedness… should I go on?
        Psychiatrists refuse to acknowledge that it can cause PTSD (and that despite such practices being officially called torture by the UN) – if that is not delusional I don’t know what is.

  9. Dr. Ragins,

    Thank you for pointing out what you were taught in school. Personally, I believe what you were taught was incredibly uninsightful, and I agree, “how we talk to people about their psychosis is really important.”

    I believe this because I dealt with both drug induced “psychosis” and “voices,” and drug withdrawal induced “psychosis.” I don’t personally know if the “psychosis” / awakening to the story of my dreams is relevant to reality (it’s very similar to those claiming they’ve gone through a spiritual awakening), nor did I ever imply it was to doctors. Because I knew the initial “psychosis” was an adverse effect of drugs, since it initially occurred two weeks after I was put on a neuroleptic (due to a misdiagnosis of the ADRs and withdrawal symptoms of a “safe smoking cessation med,” a NSAI, and a pain killer) and I had been told it would take two weeks for the neuroleptic to take effect. Psychiatrists need to learn that their antipsychotics can cause psychosis in at least a percentage of people, medical evidence of this has been in medical journals for 50 years now.

    Unfortunately, my doctors were either not intelligent or ethical enough to understand their new “wonder drugs” could cause “psychosis,” so I was then massively drugged. This resulted in my getting “voices” within nine days of being on put on a psychotropic drug cocktail. The “voices,” however, did end up having relevance to my real life concerns.

    To make a long story short, I was eventually weaned off all drugs and handed over most my medical records. According to my medical records, I’d been initially misdiagnosed based upon a list of lies and gossip from the people at whose home my child had been sexually abused, and their pastor, who had denied my other child a baptism on 9.11.2001. The drug induced “voices” were of these same people. I never personally confused the drug induced “voices” with the real people, however, my psychiatrist did. He actually declared my entire life a “credible fictional story,” when he realized his delusions and learned I had been handed over medical evidence of the child abuse.

    Had the psychiatrist bothered to listen to my concerns of child abuse initially, rather than listening only to the lies of the psychologist who was trying to cover up her pastor and friends’ child abuse hobby, I would not have learned about the “dirty little secret of the two original educated professions,” nor would I have a story about how absurdly stupid it is for psychiatric practitioners to assume all patients’ real life problems are “chemical imbalances” in their brains.

    I am shocked that an entire industry of doctors could be so inane as to believe that ignoring patients’ real life problems, then stigmatizing and tranquilizing patients instead, could help any patient. But that’s what you were all taught to do in school? And none of you were intelligent enough to question the wisdom of that?

  10. Dr. Mark:

    I have an idea for you. Intervention for psychosis usually takes place at the request of a family member. Instead of initially treating someone for psychosis if they are not asking for help, why not offer to treat the family members, instead? Ask family members if they would like to be sedated. I’ll bet you would have far fewer hospitalizations

    • madmom my family has all experienced psychoses through 3 generations so we are in the psych notes already, each in one another’s, as in “family history of …”.

      In defence of family members, and I have been on both sides of the fence, I think it’s very tough to see your son/daughter/mother/sister etc. struggling or in an alternative universe where their boundaries have changed. Sometimes it’s psych drugs or nothing. Between the devil and the deep blue sea.

      But I’m sure you know just what I’m talking about, having been through it yourself as a mother. It was easier for me in some ways as a mental patients than a mother of a mental patients. Although none of it was/is easy. Still battling away. Cheers, Chrys

    • Well, there are many sides to this issue. In some (many) cases the family may be the root of a problem. In others the family has done nothing wrong save for believing that the good doctors are going to help and gets co-traumatised by witnessing what the system does to their loved one. In others yet the family gets coerced into co-operation (as my family did) or their loved one will be taken away from them for unknown period of time and subjected to further abuse.
      Stopping coercive psychiatry is the first and most important thing.

  11. Hi Dr. Ragins,

    In March of 1996, I experienced my first psychotic episode.

    I was hospitalized and treated by doctors who were apparently taught in medical school and psychiatric residency to:

    1. not talk to people about their voices/delusions
    2. use the DSM with a “Chinese menu” approach to rubber-stamp individuals with bp/sz.
    3. medicate symptoms and ignore underlying medical conditions
    4. disregard the importance of taking an effective occupational history in order to recognize an occupational disease

    The “Chinese menu”/rubber-stamp-em and drug-em approach really did not work well for me, involved a lot of risks, almost killed me several times over and prolonged hazardous work conditions for myself and my coworkers.

    I feel the most ethical protocol to manage the risks involved when a person exhibits psychotic symptoms is for treating physicians to use the following Best Practice Assessment guidelines published by the British Medical Journal:

    Best Practice: Assessment of psychosis
    BMJ: helping doctors make better decisions

    Step-by-step diagnostic approach

    The evaluation of the acutely psychotic patient includes a thorough history and physical examination, as well as laboratory tests. Based on the initial findings, further diagnostic tests may be warranted.

    Organic causes must be considered and excluded before the psychosis is attributed to a primary psychotic disorder.

    The most common cause of acute psychosis is drug toxicity from recreational, prescription, or OTC drugs.

    Patients with structural brain conditions, or toxic or metabolic process presenting with psychosis, usually have other physical manifestations that are readily detectable by history, neurological examination, or routine laboratory tests.

    Brain imaging is reserved for patients with specific indications, such as head trauma or focal neurological signs. The routine use of such imaging is unlikely to reveal an underlying organic cause and is not recommended.

    Read more here: http://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

    I have an informal survey question for you and for anyone involved in MIA who is willing to respond, including Bob.

    No one is immune from psychosis, so if you experienced a psychotic symptoms would you:

    a. Seek treatment at a hospital?
    b. Other, please explain.

    I look forward to MIA answers.
    Kind Regards,
    Maria

    • I don’t mind answering your question, Maria.

      I now do suffer from what I know are long run adverse effects of the drugs I was on, “brain zaps,” which seem to react with my REM sleep, resulting in a lucid dreaming issue. This new finding seems to relate to my issue:

      http://www.pbs.org/wgbh/nova/next/body/gamma-wave-zaps-to-the-brain-induce-lucid-dreaming/

      But, according to my medical records, what was originally called “psychosis,” resulting in a psychiatric diagnosis, was actually just a dream query (and I had been improperly taken off a “safe smoking cessation med” / antidepressant, which is now commonly known to cause “brain zaps” and odd dreams anyway).

      But I had been unaware of the fact psychologists and psychiatrists think dream queries are “psychosis.” And technically they’re not, as long as the patient is aware of the fact they’re questioning a dream.

      The bottom line is, however, some doctors would claim my drug withdrawal induced, continuing lucid dreaming issue is “psychosis,” and want to majorly tranquilize me with massive drug cocktails. And my personal experience with hospitals is so violently appalling, that I actually pray to God I never have to be in a hospital as a patient for any reason ever again in my life.

      And I don’t mind learning about what’s going on in my dreams, it’s a little like Jung’s experiments into the unconscious. Plus, garnering an understanding into my dreams has given me insight into the inspiration for my paintings.

      But, the powerful dreams were unusual and unexpected when they first started. Now, it’s just inspiration for a book someday – which ironically, is exactly what I was medicated for believing it was in the first place. But, thirteen years later, I now know the story.

      Doctors need to learn to show more respect, IMHO. They certainly don’t know everything, and much of what they do think they know is not actually “evidence based.”